NPIMap

Organization Active NPI

Wellstreet of Georgia PC

  • Non-Pharmacy Dispensing Site
  • Lakewood, OH
National Provider Identifier
1902687759
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
WELLSTREET OF GEORGIA PC
Practice address
14800 Madison Ave
Lakewood, OH 44107-4010
Phone
(216) 925-4600
Fax
(216) 925-4601
NPI assigned
Oct 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Katie Mons
Title
District Manager
Phone
(678) 414-2824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

14800 Madison Ave
Lakewood, OH 44107-4010

Mailing address

14800 Madison Ave
Lakewood, OH 44107-4010
Phone (216) 925-4600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmons@wellstreet.com

National Provider Directory

National Provider Directory
Tax ID family
Wellstreet of Georgia PC22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1902687759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074010",
            "telephone_number": "216-925-4600",
            "fax_number": "216-925-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074010",
            "telephone_number": "216-925-4600",
            "fax_number": "216-925-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTREET OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "MONS",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "DISTRICT MANAGER",
        "authorized_official_telephone_number": "678-414-2824"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmons@wellstreet.com",
            "affiliation": "N",
            "address_1": "14800 Madison Ave",
            "city": "Lakewood",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441074010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.